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Walker L, Simpson H, Thomas AJ, Attems J. Prevalence, distribution, and severity of cerebral amyloid angiopathy differ between Lewy body diseases and Alzheimer's disease. Acta Neuropathol Commun 2024; 12:28. [PMID: 38360761 PMCID: PMC10870546 DOI: 10.1186/s40478-023-01714-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 02/17/2024] Open
Abstract
Dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), and Parkinson's disease (PD) collectively known as Lewy body diseases (LBDs) are neuropathologically characterised by α-synuclein deposits (Lewy bodies and Lewy neurites). However, LBDs also exhibit pathology associated with Alzheimer's disease (AD) (i.e. hyperphosphorylated tau and amyloid β (Aβ). Aβ can be deposited in the walls of blood vessels in the brains of individuals with AD, termed cerebral amyloid angiopathy (CAA). The aim of this study was to investigate the type and distribution of CAA in DLB, PDD, and PD and determine if this differs from AD. CAA type, severity, and topographical distribution was assessed in 94 AD, 30 DLB, 17 PDD, and 11 PD cases, and APOE genotype evaluated in a subset of cases where available. 96.3% AD cases, 70% DLB cases and 82.4% PDD cases exhibited CAA (type 1 or type 2). However only 45.5% PD cases had CAA. Type 1 CAA accounted for 37.2% of AD cases, 10% of DLB cases, and 5.9% of PDD cases, and was not observed in PD cases. There was a hierarchical topographical distribution in regions affected by CAA where AD and DLB displayed the same distribution pattern that differed from PDD and PD. APOE ε4 was associated with severity of CAA in AD cases. Topographical patterns and severity of CAA in DLB more closely resembled AD rather than PDD, and as type 1 CAA is associated with clinical dementia in AD, further investigations are warranted into whether the increased presence of type 1 CAA in DLB compared to PDD are related to the onset of cognitive symptoms and is a distinguishing factor between LBDs. Possible alignment of the the topographical distribution of CAA and microbleeds in DLB warrants further investigation. CAA in DLB more closely resembles AD rather than PDD or PD, and should be taken into consideration when stratifying patients for clinical trials or designing disease modifying therapies.
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Affiliation(s)
- Lauren Walker
- Translational and Clinical Research Institute, Newcastle University, Edwardson building, Campus for Ageing and Vitality, Newcastle-upon-Tyne, NE4 5PL, UK.
| | - Harry Simpson
- Translational and Clinical Research Institute, Newcastle University, Edwardson building, Campus for Ageing and Vitality, Newcastle-upon-Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Edwardson building, Campus for Ageing and Vitality, Newcastle-upon-Tyne, NE4 5PL, UK
| | - Johannes Attems
- Translational and Clinical Research Institute, Newcastle University, Edwardson building, Campus for Ageing and Vitality, Newcastle-upon-Tyne, NE4 5PL, UK
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Chin KS, Holper S, Loveland P, Churilov L, Yassi N, Watson R. Prevalence of cerebral microbleeds in Alzheimer's disease, dementia with Lewy bodies and Parkinson's disease dementia: A systematic review and meta-analysis. Neurobiol Aging 2024; 134:74-83. [PMID: 38006706 DOI: 10.1016/j.neurobiolaging.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/27/2023]
Abstract
Cerebral microbleeds (CMB) are often associated with vascular risk factors and/or cerebral amyloid angiopathy and are frequently identified in people with dementia. The present study therefore aimed to estimate the pooled prevalence and associations of CMB in Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), using meta-analytic methods. Sixty-five MRI studies were included after a systematic search on major electronic databases. We found that the prevalence of CMB was comparable across the three dementia subtypes (31-36%) and was highly influenced by the MRI techniques used. CMB in AD were associated with a history of hypertension and amyloid-β burden. In contrast, CMB in DLB, despite being predominantly lobar, were associated with hypertension, but not amyloid-β burden. These findings suggest that the underlying pathophysiology of CMB in DLB might differ from that of AD. There was substantially larger number of AD studies identified and more studies evaluating CMB in Lewy body dementias are warranted.
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Affiliation(s)
- Kai Sin Chin
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Aged Care, The Royal Melbourne Hospital, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
| | - Sarah Holper
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Departments of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Paula Loveland
- Department of Aged Care, The Royal Melbourne Hospital, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Leonid Churilov
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Nawaf Yassi
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Departments of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Rosie Watson
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Aged Care, The Royal Melbourne Hospital, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
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3
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Gan J, Shi Z, Liu S, Li X, Liu Y, Zhu H, Shen L, Zhang G, Lu H, Gang B, Chen Z, Ji Y. White matter hyperintensities in cognitive impairment with Lewy body disease: a multicentre study. Eur J Neurol 2023; 30:3711-3721. [PMID: 37500565 DOI: 10.1111/ene.16002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensities (WMHs) are associated with cognitive deficits and worse clinical outcomes in dementia, but rare studies have been carried out of cognitive impairment in Lewy body disease (CI-LB) patients. The objective was to investigate the associations between WMHs and clinical manifestations in patients with CI-LB. METHODS In this retrospective multicentre cohort study, 929 patients (486 with dementia with Lewy bodies [DLB], 262 with Parkinson's disease dementia [PDD], 74 with mild cognitive impairment [MCI] with Lewy bodies [MCI-LB] and 107 with Parkinson's disease with MCI [PD-MCI]) were analysed from 22 memory clinics between January 2018 and June 2022. Demographic and clinical data were collected by reviewing medical records. WMHs were semi-quantified according to the Fazekas method. Associations between WMHs and clinical manifestations were investigated by multivariate linear or logistic regression models. RESULTS Dementia with Lewy bodies patients had the highest Fazekas scores compared with PDD, MCI-LB and PD-MCI. Multivariable regressions showed the Fazekas score was positively associated with the scores of Unified Parkinson's Disease Rating Scale Part III (p = 0.001), Hoehn-Yahn stage (p = 0.004) and total Neuropsychiatric Inventory (p = 0.001) in MCI-LB and PD-MCI patients. In patients with DLB and PDD, Fazekas scores were associated with the absence of rapid eye movement sleep behaviour disorder (p = 0.041) and scores of Unified Parkinson's Disease Rating Scale Part III (p < 0.001), Hoehn-Yahn stage (p < 0.001) and the Montreal Cognitive Assessment (p = 0.014). CONCLUSION White matter hyperintensity burden of DLB was higher than for PDD, MCI-LB and PD-MCI. The greater WMH burden was significantly associated with poorer cognitive performance, worse motor function and more severe neuropsychiatric symptoms in CI-LB.
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Affiliation(s)
- Jinghuan Gan
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhihong Shi
- Department of Neurology, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Shuai Liu
- Department of Neurology, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Xudong Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Yiming Liu
- Department of Neurology, Qilu Hospital, Shandong University, Shandong, China
| | - Hongcan Zhu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Hunan, China
| | - Guili Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Hao Lu
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Baozhi Gang
- Department of Neurology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhichao Chen
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yong Ji
- Department of Neurology, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
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Yang R, Li J, Qin Y, Zhao L, Liu R, Yang F, Jiang G. A bibliometric analysis of cerebral microbleeds and cognitive impairment. Brain Cogn 2023; 169:105999. [PMID: 37262941 DOI: 10.1016/j.bandc.2023.105999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Cerebral microbleeds (CMBs) are imaging markers for small cerebral vascular diseases, which can accumulate and impact the corresponding brain networks. CMBs can affect cognitive function, including executive function, information processing speed, and visuospatial memory. Bibliometrics is a scientific and innovative method that can analyze and visualize the scientific field quantitatively. In this study, we aimed to use bibliometric analysis to demonstrate the relationship and mechanisms between CMBs and cognitive impairment. Furthermore, we reviewed the relationship between CMBs and different cognitive disorders. The use of bibliometrics can help further clarify this relationship. METHODS We retrieved articles on CMBs and cognitive impairment from the Web of Science Core Collection. The keywords (such as stroke, dementia, and cerebral amyloid angiopathy), authors, countries, institutions and journals, in the field were visually analyzed using VOSviewer software and bibliometric websites. RESULTS This bibliometric analysis reveals the related trends of CMBs in the field of cognitive impairment. CMBs, along with other small vascular lesions, constitute the basis of cognitive impairment, and studying CMBs is essential to understand the mechanisms underlying cognitive impairment. CONCLUSION This bibliometric analysis reveals a strong link between CMBs and cognitive impairment-related diseases and that specific brain networks were affected by CMBs. This provides further insights into the possible mechanisms and causes of CMBs and cognitive impairment. The direct and indirect damage (such as oxidative stress and neuroinflammation) to the brain caused by CMBs, destruction of the frontal-subcortical circuits, elevated Cystatin C levels, and iron deposition are involved in the occurrence and development of cognitive impairment. CMBs may be a potential marker for detecting, quantifying, and predicting cognitive impairment.
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Affiliation(s)
- Rui Yang
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jia Li
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yaya Qin
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Li Zhao
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Rong Liu
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Fanhui Yang
- Department of Nuclear Medicine, Affiliated Hospital of North Sichuan Medical College North Sichuan Medical College, Nanchong, Sichuan, China.
| | - Guohui Jiang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
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Toledo JB, Abdelnour C, Weil RS, Ferreira D, Rodriguez-Porcel F, Pilotto A, Wyman-Chick KA, Grothe MJ, Kane JPM, Taylor A, Rongve A, Scholz S, Leverenz JB, Boeve BF, Aarsland D, McKeith IG, Lewis S, Leroi I, Taylor JP. Dementia with Lewy bodies: Impact of co-pathologies and implications for clinical trial design. Alzheimers Dement 2023; 19:318-332. [PMID: 36239924 PMCID: PMC9881193 DOI: 10.1002/alz.12814] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/29/2022] [Accepted: 09/09/2022] [Indexed: 02/01/2023]
Abstract
Dementia with Lewy bodies (DLB) is clinically defined by the presence of visual hallucinations, fluctuations, rapid eye movement (REM) sleep behavioral disorder, and parkinsonism. Neuropathologically, it is characterized by the presence of Lewy pathology. However, neuropathological studies have demonstrated the high prevalence of coexistent Alzheimer's disease, TAR DNA-binding protein 43 (TDP-43), and cerebrovascular pathologic cases. Due to their high prevalence and clinical impact on DLB individuals, clinical trials should account for these co-pathologies in their design and selection and the interpretation of biomarkers values and outcomes. Here we discuss the frequency of the different co-pathologies in DLB and their cross-sectional and longitudinal clinical impact. We then evaluate the utility and possible applications of disease-specific and disease-nonspecific biomarkers and how co-pathologies can impact these biomarkers. We propose a framework for integrating multi-modal biomarker fingerprints and step-wise selection and assessment of DLB individuals for clinical trials, monitoring target engagement, and interpreting outcomes in the setting of co-pathologies.
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Affiliation(s)
- Jon B Toledo
- Nantz National Alzheimer Center, Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA
| | - Carla Abdelnour
- Fundació ACE. Barcelona Alzheimer Treatment and Research Center, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Rimona S Weil
- Dementia Research Centre, Wellcome Centre for Human Neuroimaging, Movement Disorders Consortium, National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer's Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, University of Brescia, Parkinson's Disease Rehabilitation Centre, FERB ONLUS-S, Isidoro Hospital, Trescore Balneario (BG), Italy
| | - Kathryn A Wyman-Chick
- HealthPartners Center for Memory and Aging and Struthers Parkinson's Center, Saint Paul, Minnesota, USA
| | - Michel J Grothe
- Instituto de Biomedicina de Sevilla (IBiS), Unidad de Trastornos del Movimiento, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Joseph P M Kane
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Angela Taylor
- Lewy Body Dementia Association, Lilburn, Georgia, USA
| | - Arvid Rongve
- Department of Research and Innovation, Institute of Clinical Medicine (K1), Haugesund Hospital, Norway and The University of Bergen, Bergen, Norway
| | - Sonja Scholz
- Department of Neurology, National Institute of Neurological Disorders and Stroke, Neurodegenerative Diseases Research Unit, Johns Hopkins University Medical Center, Baltimore, Maryland, USA
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bradley F Boeve
- Department of Neurology and Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Ian G McKeith
- Newcastle University Translational and Clinical Research Institute (NUTCRI, Newcastle upon Tyne, UK
| | - Simon Lewis
- ForeFront Parkinson's Disease Research Clinic, School of Medical Sciences, Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - John P Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Vázquez-Justes D, Aguirregoicoa I, Fernandez L, Carnes-Vendrell A, Dakterzada F, Sanjuan L, Mena A, Piñol-Ripoll G. Clinical impact of microbleeds in patients with Alzheimer's disease. BMC Geriatr 2022; 22:774. [PMID: 36175849 PMCID: PMC9520821 DOI: 10.1186/s12877-022-03456-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/15/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Cerebral microbleeds (CMBs) are more frequent in patients with Alzheimer’s disease (AD) than in the general population. However, their clinical significance remains poorly understood. We carried out a multimodal approach to evaluate the impact of CMBs at a clinical, neuropsychological, and survival level, as well as on core AD biomarkers in the cerebrospinal fluid (CSF) in AD patients. Methods We prospectively recruited 98 patients with mild-moderate AD. At baseline, they underwent brain MRI, and AD CSF biomarkers and APOE genotypes were analysed. An extensive neuropsychological battery was performed at baseline and after 1 year of follow-up. We analysed the stroke incidence and mortality with survival analyses. Results Forty-eight (48.5%) patients had at least one CMBs. Eight (8.2%) patients had strictly nonlobar CMBs, 39 (40.2%) had any lobar CMB locations. The incidence of stroke was higher in AD patients with lobar CMBs than in those without CMBs (p < 0.05). Mortality did not differ among groups (p > 0.05). At the cognitive level, CMBs patients deteriorated more rapidly at 12 months according to MMSE scores, with no differences observed at 24 months. We did not observe differences in the other tests, except for an increase in caregiver burden in the CMBs group. The presence of cerebral amyloidosis and APOE ε4 were associated with a greater presence of CMBs. Conclusion CMBs are associated with an increased risk of ischemic stroke in AD patients without differences in mortality. Patients with CMBs did not seem to have different consequences associated with cognitive decline except for an increase in caregiver overload.
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Affiliation(s)
- Daniel Vázquez-Justes
- Neurology Department, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Iván Aguirregoicoa
- Radiology Department, Hospital General Barbastro, Salud Aragón, Barbastro, Spain
| | - Leandre Fernandez
- Radiology Department, Hospital Universitari Santa Maria, IRBLleida, Lleida, Spain
| | - Anna Carnes-Vendrell
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, Hospital Universitari Santa Maria, IRBLleida, Lleida, Spain
| | - Faride Dakterzada
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, Hospital Universitari Santa Maria, IRBLleida, Lleida, Spain
| | - Laura Sanjuan
- Radiology Department, Hospital General Barbastro, Salud Aragón, Barbastro, Spain
| | - Andreu Mena
- Radiology Department, Hospital General Barbastro, Salud Aragón, Barbastro, Spain
| | - Gerard Piñol-Ripoll
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, Hospital Universitari Santa Maria, IRBLleida, Lleida, Spain. .,Cognitive Disorders Unit, Hospital Universitari Santa Maria, Rovira Roure n° 44. 25198, Lleida, Spain.
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Hou M, Hou X, Qiu Y, Wang J, Zhang M, Mao X, Wu X. Characteristics of Cognitive Impairment and Their Relationship With Total Cerebral Small Vascular Disease Score in Parkinson's Disease. Front Aging Neurosci 2022; 14:884506. [PMID: 35875803 PMCID: PMC9301002 DOI: 10.3389/fnagi.2022.884506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background This study aimed to investigate the characteristics of cognitive dysfunctions and their relationship with total cerebral small vascular disease (CSVD) in Parkinson’s disease (PD). Methods A total of 174 idiopathic PD patients who underwent brain magnetic resonance imaging (MRI) were recruited. Demographic information, vascular disease risk factors, motor function (MDS-UPDRS III score), and cognitive level (MoCA, MMSE) were collected for these patients. The total CSVD burden was scored based on lacunes, enlarged perivascular spaces (EPVS), high-grade white matter hyperintensities (WMH), and cerebral microbleeds (CMBs) for each subject. Results Cognitive scores on MoCA for language, delayed recall, and orientation were significantly reduced in PD patients with CSVD burden ≥ 1 than in those with CSVD burden = 0. Educational level, PDQ 39, and CSVD burden were significantly associated with MoCA scores in individuals with PD. For the whole group, the full model accounted for 33.6% variation in total MoCA scores. In which, CSVD burden explained 2.7% of the results, and the detection of lacunes, WMH, EPVS, and strictly lobar CMBs were significantly correlated with MoCA scores. The stability of the outcomes was confirmed by sensitivity analysis. Conclusion CSVD can independently contribute to cognitive decline in PD and cause damage in specific cognitive domains. Promoting neurovascular health may help preserve cognitive functions in PD.
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Affiliation(s)
- Miaomiao Hou
- Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Hou
- Department of Neurology, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yiqing Qiu
- Department of Neurosurgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jiali Wang
- Department of Neurosurgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Mingyang Zhang
- Department of Chemistry, University of Utah, Salt Lake City, UT, United States
| | - Xiaowei Mao
- Department of Neurology, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xi Wu
- Department of Neurosurgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
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8
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Hijazi Z, Yassi N, O'Brien JT, Watson R. The influence of cerebrovascular disease in dementia with Lewy bodies and Parkinson's disease dementia. Eur J Neurol 2021; 29:1254-1265. [PMID: 34923713 DOI: 10.1111/ene.15211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Lewy body dementia (LBD), including dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is a common form of neurodegenerative dementia. The frequency and influence of comorbid cerebrovascular disease is not understood but has potentially important clinical management implications. METHODS A systematic literature search was conducted (Medline and Embase) for studies including participants with DLB and/or PDD assessing cerebrovascular lesions (imaging and pathological studies). They included white matter changes, cerebral amyloid angiopathy (CAA), cerebral microbleeds (CMB), macroscopic infarcts, micro-infarcts and intracerebral haemorrhage. RESULTS Of 4411 articles, 63 studies were included. Cerebrovascular lesions commonly studied included white matter changes (41 studies) and CMB (18 studies). There was an increased severity of white matter changes on magnetic resonance imaging (visualized as white matter hyperintensities, WMH), but not neuropathology, in LBD compared to PD without dementia and age-matched controls. CMB prevalence in DLB was highly variable but broadly similar to Alzheimer's disease (AD) (0-48%), with a lobar predominance. No relationship was found between large cortical or small subcortical infarcts or intracerebral haemorrhage and presence of LBD. CONCLUSION The underlying mechanisms of WMH in LBD require further exploration, as their increased severity in LBD was not supported by neuropathological examination of white matter. CMB in LBD had a similar prevalence as AD. There is a need for larger studies assessing the influence of cerebrovascular lesions on clinical symptoms, disease progression and outcomes.
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Affiliation(s)
- Zina Hijazi
- Monash University School of Rural Health, Bendigo Hospital, Bendigo, VIC, Australia.,Department of Medicine, Bendigo Hospital, Bendigo, VIC, Australia
| | - Nawaf Yassi
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.,Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Level E4, Box 189, Cambridge, CB2 0QC, UK
| | - Rosie Watson
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.,Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
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Mendes A, Noblet V, Mondino M, Loureiro de Sousa P, Manji S, Archenault A, Casanovas M, Bousiges O, Philippi N, Baloglu S, Rauch L, Cretin B, Demuynck C, Martin-Hunyadi C, Blanc F. Association of cerebral microbleeds with cerebrospinal fluid Alzheimer-biomarkers and clinical symptoms in early dementia with Lewy bodies. Int J Geriatr Psychiatry 2021; 36:851-857. [PMID: 33300151 DOI: 10.1002/gps.5485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 10/11/2020] [Accepted: 11/29/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine the prevalence, localization and associations of cerebral microbleeds (CMB) in dementia with Lewy bodies (DLB) with its core clinical symptoms and cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD). We hypothesize DLB patients with CMB have increased amyloid burden compared to those without CMB, which could also translate into clinical differences. METHODS Retrospective cross-sectional analysis from the AlphaLewyMA study (https://clinicaltrials.gov/ct2/show/NCT01876459). Patients underwent a standardized protocol of brain MRI including 3D T1, 3D FLAIR and T2* sequences, and CSF analysis of AD biomarkers. CMB and white matter hyperintensities (WMHs) were visually assessed in prodromal and mild demented (DLB, N = 91) and AD (AD, N = 67) patients. RESULTS CMB prevalence did not differ among DLB and AD (24.2% vs. 37.3%; p = 0.081). CMB were mainly distributed in lobar topographies in both DLB (74%) and AD (89%). CMB in DLB was not associated with global cognitive performance, executive functioning, speed of information processing, or AD CSF biomarkers. Similarly, there was no difference regarding specific clinical symptoms: fluctuations, psychotic phenomena, sleep behavior disorder and Parkinsonism between DLB patients with and without CMB. AD patients with CMB had increased burden of WMH compared to those without (2.1 ± 0.86 vs. 1.4 ± 0.89; p = 0.005), according to Fazekas scale, whereas no significant difference was observed in DLB patients (1.68 ± 0.95 vs. 1.42 ± 0.91; p = 0.25). CONCLUSION CMB were equally prevalent with similar topographic distribution in both DLB and AD patients. CMB was not associated with CSF AD biomarkers or core clinical symptoms in DLB.
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Affiliation(s)
- Aline Mendes
- Division of Geriatrics and Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent Noblet
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Mary Mondino
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Paulo Loureiro de Sousa
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Sumayya Manji
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Anne Archenault
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Michel Casanovas
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Olivier Bousiges
- Laboratoire de Biochimie et Biologie Moléculaire, University Hospital of Strasbourg, Strasbourg, France.,Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), UMR 7364, CNRS, Strasbourg, France.,Neuroradiology Service, University Hospital of Strasbourg, Strasbourg, France
| | - Nathalie Philippi
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France.,Memory Resources and Research Centre (CM2R), Geriatrics Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospital of Strasbourg, Strasbourg, France
| | - Seyyid Baloglu
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France.,Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), UMR 7364, CNRS, Strasbourg, France
| | - Lucie Rauch
- Memory Resources and Research Centre (CM2R), Geriatrics Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospital of Strasbourg, Strasbourg, France
| | - Benjamin Cretin
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France.,Memory Resources and Research Centre (CM2R), Geriatrics Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospital of Strasbourg, Strasbourg, France
| | - Catherine Demuynck
- Memory Resources and Research Centre (CM2R), Geriatrics Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospital of Strasbourg, Strasbourg, France
| | - Catherine Martin-Hunyadi
- Memory Resources and Research Centre (CM2R), Geriatrics Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospital of Strasbourg, Strasbourg, France
| | - Frederic Blanc
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France.,Memory Resources and Research Centre (CM2R), Geriatrics Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospital of Strasbourg, Strasbourg, France
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10
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Jäkel L, De Kort AM, Klijn CJM, Schreuder FHBM, Verbeek MM. Prevalence of cerebral amyloid angiopathy: A systematic review and meta-analysis. Alzheimers Dement 2021; 18:10-28. [PMID: 34057813 PMCID: PMC9290643 DOI: 10.1002/alz.12366] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 01/05/2023]
Abstract
Reported prevalence estimates of sporadic cerebral amyloid angiopathy (CAA) vary widely. CAA is associated with cognitive dysfunction and intracerebral hemorrhage, and linked to immunotherapy‐related side‐effects in Alzheimer's disease (AD). Given ongoing efforts to develop AD immunotherapy, accurate estimates of CAA prevalence are important. CAA can be diagnosed neuropathologically or during life using MRI markers including strictly lobar microbleeds. In this meta‐analysis of 170 studies including over 73,000 subjects, we show that in patients with AD, CAA prevalence based on pathology (48%) is twice that based on presence of strictly lobar cerebral microbleeds (22%); in the general population this difference is three‐fold (23% vs 7%). Both methods yield similar estimated prevalences of CAA in cognitively normal elderly (5% to 7%), in patients with intracerebral hemorrhage (19% to 24%), and in patients with lobar intracerebral hemorrhage (50% to 57%). However, we observed large heterogeneity among neuropathology and MRI protocols, which calls for standardized assessment and reporting of CAA.
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Affiliation(s)
- Lieke Jäkel
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Anna M De Kort
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Marcel M Verbeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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11
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Ferreira D, Nedelska Z, Graff-Radford J, Przybelski SA, Lesnick TG, Schwarz CG, Botha H, Senjem ML, Fields JA, Knopman DS, Savica R, Ferman TJ, Graff-Radford NR, Lowe VJ, Jack CR, Petersen RC, Lemstra AW, van de Beek M, Barkhof F, Blanc F, Loureiro de Sousa P, Philippi N, Cretin B, Demuynck C, Hort J, Oppedal K, Boeve BF, Aarsland D, Westman E, Kantarci K. Cerebrovascular disease, neurodegeneration, and clinical phenotype in dementia with Lewy bodies. Neurobiol Aging 2021; 105:252-261. [PMID: 34130107 DOI: 10.1016/j.neurobiolaging.2021.04.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
We investigated whether cerebrovascular disease contributes to neurodegeneration and clinical phenotype in dementia with Lewy bodies (DLB). Regional cortical thickness and subcortical gray matter volumes were estimated from structural magnetic resonance imaging (MRI) in 165 DLB patients. Cortical and subcortical infarcts were recorded and white matter hyperintensities (WMHs) were assessed. Subcortical only infarcts were more frequent (13.3%) than cortical only infarcts (3.1%) or both subcortical and cortical infarcts (2.4%). Infarcts, irrespective of type, were associated with WMHs. A higher WMH volume was associated with thinner orbitofrontal, retrosplenial, and posterior cingulate cortices, smaller thalamus and pallidum, and larger caudate volume. A higher WMH volume was associated with the presence of visual hallucinations and lower global cognitive performance, and tended to be associated with the absence of probable rapid eye movement sleep behavior disorder. Presence of infarcts was associated with the absence of parkinsonism. We conclude that cerebrovascular disease is associated with gray matter neurodegeneration in patients with probable DLB, which may have implications for the multifactorial treatment of probable DLB.
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Affiliation(s)
- Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Zuzana Nedelska
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | | | | | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Afina W Lemstra
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, Netherlands
| | - Marleen van de Beek
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands; Queen Square Institute of Neurology, University College London, London, UK
| | - Frederic Blanc
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Paulo Loureiro de Sousa
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Nathalie Philippi
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Benjamin Cretin
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Catherine Demuynck
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Jakub Hort
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic; International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ketil Oppedal
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway; Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | | | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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12
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Jellinger KA. Significance of cerebral amyloid angiopathy and other co-morbidities in Lewy body diseases. J Neural Transm (Vienna) 2021; 128:687-699. [PMID: 33928445 DOI: 10.1007/s00702-021-02345-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/22/2021] [Indexed: 01/12/2023]
Abstract
Lewy body dementia (LBD) and Parkinson's disease-dementia (PDD) are two major neurocognitive disorders with Lewy bodies (LB) of unknown etiology. There is considerable clinical and pathological overlap between these two conditions that are clinically distinguished based on the duration of Parkinsonism prior to development of dementia. Their morphology is characterized by a variable combination of LB and Alzheimer's disease (AD) pathologies. Cerebral amyloid angiopathy (CAA), very common in aged persons and particularly in AD, is increasingly recognized for its association with both pathologies and dementia. To investigate neuropathological differences between LB diseases with and without dementia, 110 PDD and 60 LBD cases were compared with 60 Parkinson's disease (PD) cases without dementia (PDND). The major demographic and neuropathological data were assessed retrospectively. PDD patients were significantly older than PDND ones (83.9 vs 77.8 years; p < 0.05); the age of LB patients was in between both groups (mean 80.2 years), while the duration of disease was LBD < PDD < PDND (mean 6.7 vs 12.5 and 14.3 years). LBD patients had higher neuritic Braak stages (mean 5.1 vs 4.5 and 4.0, respectively), LB scores (mean 5.3 vs 4.2 and 4.0, respectively), and Thal amyloid phases (mean 4.1 vs 3.0 and 2.3, respectively) than the two other groups. CAA was more common in LBD than in the PDD and PDND groups (93 vs 50 and 21.7%, respectively). Its severity was significantly greater in LBD than in PDD and PDND (p < 0.01), involving mainly the occipital lobes. Moreover, striatal Aβ deposition highly differentiated LBD brains from PDD. Braak neurofibrillary tangle (NFT) stages, CAA, and less Thal Aβ phases were positively correlated with LB pathology (p < 0.05), which was significantly higher in LBD than in PDD < PDND. Survival analysis showed worse prognosis in LBD than in PDD (and PDND), which was linked to both increased Braak tau stages and more severe CAA. These and other recent studies imply the association of CAA-and both tau and LB pathologies-with cognitive decline and more rapid disease progression that distinguishes LBD from PDD (and PDND).
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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13
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Hansen D, Ling H, Lashley T, Foley JA, Strand C, Eid TM, Holton JL, Warner TT. Novel clinicopathological characteristics differentiate dementia with Lewy bodies from Parkinson's disease dementia. Neuropathol Appl Neurobiol 2020; 47:143-156. [PMID: 32720329 DOI: 10.1111/nan.12648] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 01/09/2023]
Abstract
Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) known as Lewy body dementias have overlapping clinical and neuropathological features. Neuropathology in both includes combination of Lewy body and Alzheimer's disease (AD) pathology. Cerebral amyloid angiopathy (CAA), often seen in AD, is increasingly recognized for its association with dementia. AIMS This study investigated clinical and neuropathological differences between DLB and PDD. METHODS 52 PDD and 16 DLB cases from the Queen Square Brain Bank (QSBB) for Neurological disorders were included. Comprehensive clinical data of motor and cognitive features were obtained from medical records. Neuropathological assessment included examination of CAA, Lewy body and AD pathology. RESULTS CAA was more common in DLB than in PDD (P = 0.003). The severity of CAA was greater in DLB than in PDD (P = 0.009), with significantly higher CAA scores in the parietal lobe (P = 0.043), and the occipital lobe (P = 0.008), in DLB than in PDD. The highest CAA scores were observed in cases with APOE ε4/4 and ε2/4. Survival analysis showed worse prognosis in DLB, as DLB reached each clinical milestone sooner than PDD. Absence of dyskinesia in DLB is linked to the significantly lower lifetime cumulative dose of levodopa in comparison with PDD. CONCLUSIONS This is the first study which identified prominent concurrent CAA pathology as a pathological substrate of DLB. More prominent CAA and rapid disease progression as measured by clinical milestones distinguish DLB from PDD.
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Affiliation(s)
- D Hansen
- Reta Lila Weston Institute, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - H Ling
- Reta Lila Weston Institute, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - T Lashley
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.,Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - J A Foley
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - C Strand
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - T M Eid
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.,Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - J L Holton
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - T T Warner
- Reta Lila Weston Institute, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.,National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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14
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Donaghy PC, Firbank M, Mitra D, Petrides G, Lloyd J, Barnett N, Olsen K, Thomas AJ, O'Brien JT. Microbleeds in dementia with Lewy bodies. J Neurol 2020; 267:1491-1498. [PMID: 32016624 PMCID: PMC7184053 DOI: 10.1007/s00415-020-09736-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Microbleeds are associated with the development of dementia in older people and are common in Alzheimer's disease (AD). Their prevalence and clinical importance in dementia with Lewy bodies (DLB) is unclear. The objective of this study was to compare the rates of microbleeds in DLB with those in AD and healthy older people, and investigate associations between microbleeds and amyloid deposition, vascular risk and disease severity in DLB. METHODS DLB (n = 30), AD (n = 18) and control (n = 20) participants underwent clinical assessment at baseline and 1 year in this longitudinal observational study. 3T MRI (including T2* susceptibility weighted imaging) and florbetapir PET were carried out at baseline. Microbleeds were rated visually and a standardised uptake value ratio (SUVR) was calculated from florbetapir PET scans. RESULTS 40% of DLB subjects had microbleeds compared with 50% of AD and 15% of controls. Compared to DLB without microbleeds, those with microbleeds had higher systolic BP (156 ± 26 v. 135 ± 19 mmHg; p = 0.03), but did not have greater levels of vascular disease or amyloid deposition (SUVR 1.25 ± 0.24 v. 1.25 ± 0.22; p = 0.33). There was evidence of less severe dementia in DLB participants with microbleeds, but these differences may have been driven by a shorter disease duration in those with microbleeds. CONCLUSION The presence of microbleeds in DLB is associated with higher blood pressure, but not with other measures of vascular disease or amyloid deposition. The relationship between microbleeds and clinical presentation remains unclear.
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Affiliation(s)
- Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dipayan Mitra
- Neuroradiology Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - George Petrides
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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15
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Hansen D, Ling H, Lashley T, Holton JL, Warner TT. Review: Clinical, neuropathological and genetic features of Lewy body dementias. Neuropathol Appl Neurobiol 2019; 45:635-654. [PMID: 30977926 DOI: 10.1111/nan.12554] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/09/2019] [Indexed: 01/08/2023]
Abstract
Lewy body dementias are the second most common neurodegenerative dementias after Alzheimer's disease and include dementia with Lewy bodies and Parkinson's disease dementia. They share similar clinical and neuropathological features but differ in the time of dementia and parkinsonism onset. Although Lewy bodies are their main pathological hallmark, several studies have shown the emerging importance of Alzheimer's disease pathology. Clinical amyloid-β imaging using Pittsburgh Compound B (PiB) supports neuropathological studies which found that amyloid-β pathology is more common in dementia with Lewy bodies than in Parkinson's disease dementia. Nevertheless, other co-occurring pathologies, such as cerebral amyloid angiopathy, TDP-43 pathology and synaptic pathology may also influence the development of neurodegeneration and dementia. Recent genetic studies demonstrated an important role of APOE genotype and other genes such as GBA and SNCA which seem to be involved in the pathophysiology of Lewy body dementias. The aim of this article is to review the main clinical, neuropathological and genetic aspects of dementia with Lewy bodies and Parkinson's disease dementia. This is particularly relevant as future management for these two conditions may differ.
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Affiliation(s)
- D Hansen
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK
| | - H Ling
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - T Lashley
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - J L Holton
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - T T Warner
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
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16
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Nanodelivery of cerebrolysin reduces pathophysiology of Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2019; 245:201-246. [DOI: 10.1016/bs.pbr.2019.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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17
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Balážová Z, Nováková M, Minsterová A, Rektorová I. Structural and Functional Magnetic Resonance Imaging of Dementia With Lewy Bodies. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 144:95-141. [PMID: 30638458 DOI: 10.1016/bs.irn.2018.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Dementia with Lewy bodies (DLB) is the second most common cause of neurodegenerative dementia after Alzheimer's disease (AD). Although diagnosis may be challenging, there is increasing evidence that the use of biomarkers according to 2017 revised criteria for diagnosis and management of dementia with Lewy bodies can increase diagnostic accuracy. Apart from nuclear medicine techniques, various magnetic resonance imaging (MRI) techniques have been utilized in attempt to enhance diagnostic accuracy. This chapter reviews structural, functional and diffusion MRI studies in DLB cohorts being compared to healthy controls, AD or dementia in Parkinson's disease (PDD). We also included relatively new MRI methods that may have potential to identify early DLB subjects and aim at examining brain iron and neuromelanin.
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Affiliation(s)
- Zuzana Balážová
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic; Department of Radiology and Nuclear Medicine, University Hospital Brno, Faculty of Medicine, Brno, Czech Republic
| | - Marie Nováková
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic
| | - Alžběta Minsterová
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic
| | - Irena Rektorová
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic; St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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18
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Yang HJ. Cerebral Microbleeds and the Heterogeneity of Parkinson's Disease. J Korean Med Sci 2018; 33:e293. [PMID: 30416411 PMCID: PMC6221860 DOI: 10.3346/jkms.2018.33.e293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hui-Jun Yang
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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19
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Kim KJ, Bae YJ, Kim JM, Kim BJ, Oh ES, Yun JY, Kim JS, Kim HJ. The Prevalence of Cerebral Microbleeds in Non-Demented Parkinson's Disease Patients. J Korean Med Sci 2018; 33:e289. [PMID: 30416409 PMCID: PMC6221857 DOI: 10.3346/jkms.2018.33.e289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/12/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cerebral microbleeds (CMBs) are associated with cerebrovascular risk factors and cognitive dysfunction among patients with Parkinson's disease (PD). However, whether CMBs themselves are associated with PD is to be elucidated. METHODS We analyzed the presence of CMBs using 3-Tesla brain magnetic resonance imaging in non-demented patients with PD and in age-, sex-, and hypertension-matched control subjects. PD patients were classified according to their motor subtypes: tremor-dominant, intermediate, and postural instability-gait disturbance (PIGD). Other cerebrovascular risk factors and small vessel disease (SVD) burdens were also evaluated. RESULTS Two-hundred and five patients with PD and 205 control subjects were included. The prevalence of CMBs was higher in PD patients than in controls (16.1% vs. 8.8%; odds ratio [OR], 2.126; P = 0.019); CMBs in the lobar area showed a significant difference between PD patients and controls (11.7% vs. 5.9%; OR, 2.234; P = 0.032). According to the motor subtype, CMBs in those with PIGD type showed significant difference from controls with respect to the overall brain area (21.1% vs. 8.9%; OR, 2.759; P = 0.010) and lobar area (14.6% vs. 4.9%; OR, 3.336; P = 0.016). Among PD patients, those with CMBs had higher age and more evidence of SVDs than those without CMBs. CONCLUSION We found that CMBs are more frequent in PD patients than in controls, especially in those with the PIGD subtype and CMBs on the lobar area. Further study investigating the pathogenetic significance of CMBs is required.
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Affiliation(s)
- Kyeong Joon Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eung Seok Oh
- Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ji Young Yun
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ji Seon Kim
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University Hospital, Seoul National University College of Medicine, Seongnam, Korea
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20
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The presence of cerebral microbleeds is associated with cognitive impairment in Parkinson's disease. J Neurol Sci 2018; 393:39-44. [DOI: 10.1016/j.jns.2018.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 01/08/2023]
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Jellinger KA, Korczyn AD. Are dementia with Lewy bodies and Parkinson's disease dementia the same disease? BMC Med 2018; 16:34. [PMID: 29510692 PMCID: PMC5840831 DOI: 10.1186/s12916-018-1016-8] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/30/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), which share many clinical, neurochemical, and morphological features, have been incorporated into DSM-5 as two separate entities of major neurocognitive disorders with Lewy bodies. Despite clinical overlap, their diagnosis is based on an arbitrary distinction concerning the time of onset of motor and cognitive symptoms, namely as early cognitive impairment in DLB and later onset following that of motor symptoms in PDD. Their morphological hallmarks - cortical and subcortical α-synuclein/Lewy body plus β-amyloid and tau pathologies - are similar, but clinical differences at onset suggest some dissimilar profiles. Based on recent publications, including the fourth consensus report of the DLB Consortium, a critical overview is provided herein. DISCUSSION The clinical constellations of DLB and PDD include cognitive impairment, parkinsonism, visual hallucinations, and fluctuating attention. Intravitam PET and postmortem studies have revealed a more pronounced cortical atrophy, elevated cortical and limbic Lewy body pathologies, higher Aβ and tau loads in cortex and striatum in DLB compared to PDD, and earlier cognitive defects in DLB. Conversely, multitracer PET studies have shown no differences in cortical and striatal cholinergic and dopaminergic deficits. Clinical management of both DLB and PDD includes cholinesterase inhibitors and other pharmacologic and non-drug strategies, yet with only mild symptomatic effects. Currently, no disease-modifying therapies are available. CONCLUSION DLB and PDD are important dementia syndromes that overlap in many clinical features, genetics, neuropathology, and management. They are currently considered as subtypes of an α-synuclein-associated disease spectrum (Lewy body diseases), from incidental Lewy body disease and non-demented Parkinson's disease to PDD, DLB, and DLB with Alzheimer's disease at the most severe end. Cognitive impairment in these disorders is induced not only by α-synuclein-related neurodegeneration but by multiple regional pathological scores. Both DLB and PDD show heterogeneous pathology and neurochemistry, suggesting that they share important common underlying molecular pathogenesis with Alzheimer's disease and other proteinopathies. While we prefer to view DLB and PDD as extremes on a continuum, there remains a pressing need to more clearly differentiate these syndromes and to understand the synucleinopathy processes leading to either one.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, A-1150, Vienna, Austria.
| | - Amos D Korczyn
- Tel-Aviv University, Sackler Faculty of Medicine, Ramat Aviv, Israel
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22
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Cheng CK, Tsao YC, Su YC, Sung FC, Tai HC, Kung WM. Metabolic Risk Factors of Alzheimer's Disease, Dementia with Lewy Bodies, and Normal Elderly: A Population-Based Study. Behav Neurol 2018; 2018:8312346. [PMID: 29971140 PMCID: PMC6008802 DOI: 10.1155/2018/8312346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/17/2018] [Accepted: 05/09/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) share many risk factors. Evidence suggests that metabolic risk factors are important to AD; however, their association with DLB is unclear. The risk of cardiovascular diseases (CVD) associated with AD and DLB is also uncertain. Thus, this nationwide, population-based study was designed to evaluate the metabolic and CVD risks in AD and DLB. MATERIALS AND METHODS Data were obtained from the Taiwan National Health Insurance Research Database. AD patients, DLB patients, and normal control (NC) individuals from 1996 to 2013 were enrolled for risk assessment. RESULTS In total, 7544 NC individuals, 1324 AD patients, and 562 DLB patients were enrolled. Participants with one or more metabolic risk factors had significantly higher odds of AD or DLB. No significant differences in metabolic risk factors were observed between DLB and AD patients. AD patients had a lower risk of CVD (aHR = 0.67, 95% CI = 0.59-0.76, p value < 0.001) and coronary artery disease (CAD) (aHR = 0.59, 95% CI = 0.51-0.69, p value < 0.001) than NC. DLB patients had a higher risk of ischemic stroke (aHR = 2.27, 95% CI = 1.68-3.06, p value < 0.001) than NC. CONCLUSION Metabolic risk factors are important in AD and DLB. Patients with AD might have a lower risk of CAD and ischemic strokes. Patients with DLB might have a higher risk of ischemic stroke.
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Affiliation(s)
- Chih-Kuang Cheng
- 1Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chien Tsao
- 2Department of Internal Medicine, Yonghe Cardinal Tien Hospital, Taipei, Taiwan
- 3Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 4School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuan-Chih Su
- 5Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- 6College of Medicine, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- 7Department of Public Health, China Medical University, Taichung, Taiwan
| | - Hsu-Chih Tai
- 8Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
| | - Woon-Man Kung
- 8Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
- 9Division of Neurosurgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- 10Department of Surgery, School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
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23
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Jellinger KA. Dementia with Lewy bodies and Parkinson's disease-dementia: current concepts and controversies. J Neural Transm (Vienna) 2017; 125:615-650. [PMID: 29222591 DOI: 10.1007/s00702-017-1821-9] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/28/2017] [Indexed: 12/15/2022]
Abstract
Dementia with Lewy bodies (DLB) and Parkinson's disease-dementia (PDD), although sharing many clinical, neurochemical and morphological features, according to DSM-5, are two entities of major neurocognitive disorders with Lewy bodies of unknown etiology. Despite considerable clinical overlap, their diagnosis is based on an arbitrary distinction between the time of onset of motor and cognitive symptoms: dementia often preceding parkinsonism in DLB and onset of cognitive impairment after onset of motor symptoms in PDD. Both are characterized morphologically by widespread cortical and subcortical α-synuclein/Lewy body plus β-amyloid and tau pathologies. Based on recent publications, including the fourth consensus report of the DLB Consortium, a critical overview is given. The clinical features of DLB and PDD include cognitive impairment, parkinsonism, visual hallucinations, and fluctuating attention. Intravitam PET and post-mortem studies revealed more pronounced cortical atrophy, elevated cortical and limbic Lewy pathologies (with APOE ε4), apart from higher prevalence of Alzheimer pathology in DLB than PDD. These changes may account for earlier onset and greater severity of cognitive defects in DLB, while multitracer PET studies showed no differences in cholinergic and dopaminergic deficits. DLB and PDD sharing genetic, neurochemical, and morphologic factors are likely to represent two subtypes of an α-synuclein-associated disease spectrum (Lewy body diseases), beginning with incidental Lewy body disease-PD-nondemented-PDD-DLB (no parkinsonism)-DLB with Alzheimer's disease (DLB-AD) at the most severe end, although DLB does not begin with PD/PDD and does not always progress to DLB-AD, while others consider them as the same disease. Both DLB and PDD show heterogeneous pathology and neurochemistry, suggesting that they share important common underlying molecular pathogenesis with AD and other proteinopathies. Cognitive impairment is not only induced by α-synuclein-caused neurodegeneration but by multiple regional pathological scores. Recent animal models and human post-mortem studies have provided important insights into the pathophysiology of DLB/PDD showing some differences, e.g., different spreading patterns of α-synuclein pathology, but the basic pathogenic mechanisms leading to the heterogeneity between both disorders deserve further elucidation. In view of the controversies about the nosology and pathogenesis of both syndromes, there remains a pressing need to differentiate them more clearly and to understand the processes leading these synucleinopathies to cause one disorder or the other. Clinical management of both disorders includes cholinesterase inhibitors, other pharmacologic and nonpharmacologic strategies, but these have only a mild symptomatic effect. Currently, no disease-modifying therapies are available.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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24
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He D, Liu CF, Chu L, Li Y, Xu DF, Jiao L. The risk factors and pattern of cerebral microbleeds in Parkinson's disease. Int J Neurosci 2017; 127:909-914. [PMID: 28051884 DOI: 10.1080/00207454.2017.1278590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral microbleeds (CMBs) in Parkinson's disease (PD) have been reported recently and concerned increasingly. Our aim was to investigate the risk factors and pattern of CMBs in patients with PD, as well as the influence of risk factors on the pattern of CMBs. METHODS We retrospectively collected medical and imaging data of 247 patients who underwent brain susceptibility-weighted imaging. Logistic regression analyses were performed to determine the risk factors of CMBs. The frequency and amount of CMBs in different locations between patients with and without risk factors were analyzed. RESULTS Of the 247 patients with PD, 39 (15.79%) had CMBs, 27 (69.23%) had lobar CMBs, 20 (51.28%) had deep CMBs and 17 (43.59%) had infratentorial CMBs. A history of cerebral ischemic events was independently associated with the presence of CMBs (odds ratio (OR) 4.485 [95% CI 2.150-9.356]; p = 0.000), especially with lobar and deep CMBs. Hypertension and Hoehn and Yahr score were also associated with the presence of deep CMBs. Only white matter hyperintensities were independently associated with the presence of infratentorial CMBs. Compared to patients without risk factors, the frequency of deep CMBs was greater in those with a history of cerebral ischemic events (p = 0.013), while the amount of deep CMBs was higher in those with hypertension (p = 0.035). CONCLUSION CMBs in PD seem to present a lobe-dominant pattern. A history of cerebral ischemic events and hypertension may be two strong risk factors which preferentially influences the pattern of deep CMBs in PD.
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Affiliation(s)
- Dian He
- a Department of Neurology , The Second Affiliated Hospital of Soochow University , Soochow University , Suzhou , China.,b Department of Neurology , Affiliated Hospital of Guizhou Medical University , Guiyang , China
| | - Chun-Feng Liu
- a Department of Neurology , The Second Affiliated Hospital of Soochow University , Soochow University , Suzhou , China.,c Institute of Neuroscience , Soochow University , Suzhou , China
| | - Lan Chu
- b Department of Neurology , Affiliated Hospital of Guizhou Medical University , Guiyang , China.,c Institute of Neuroscience , Soochow University , Suzhou , China
| | - Ya Li
- b Department of Neurology , Affiliated Hospital of Guizhou Medical University , Guiyang , China
| | - Da-Fei Xu
- b Department of Neurology , Affiliated Hospital of Guizhou Medical University , Guiyang , China
| | - Ling Jiao
- b Department of Neurology , Affiliated Hospital of Guizhou Medical University , Guiyang , China
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25
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Zivadinov R, Ramasamy DP, Benedict RRH, Polak P, Hagemeier J, Magnano C, Dwyer MG, Bergsland N, Bertolino N, Weinstock-Guttman B, Kolb C, Hojnacki D, Utriainen D, Haacke EM, Schweser F. Cerebral Microbleeds in Multiple Sclerosis Evaluated on Susceptibility-weighted Images and Quantitative Susceptibility Maps: A Case-Control Study. Radiology 2016; 281:884-895. [PMID: 27308776 DOI: 10.1148/radiol.2016160060] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose To assess cerebral microbleed (CMB) prevalence in patients with multiple sclerosis (MS) and clinically isolated syndrome (CIS) and associations with clinical outcomes. Materials and Methods CMBs are associated with aging and neurodegenerative disorders. The prevalence of CMBs has not previously been well established. In this study, 445 patients with MS (266 with relapsing-remitting MS, 138 with secondary progressive MS, and 41 with primary progressive MS), 45 patients with CIS, 51 patients with other neurological diseases, and 177 healthy control subjects (HCs) underwent 3-T magnetic resonance (MR) imaging and clinical examinations. A subset of 168 patients with MS and 50 HCs underwent neuropsychological testing. Number of CMBs was assessed on susceptibility-weighted minimum intensity projections by using the Microbleed Anatomic Rating Scale; volume was calculated by using quantitative susceptibility maps. Differences between groups were analyzed with the χ2 test, Fisher exact test, Student t test, and analysis of variance; associations of CMBs with clinical and other MR imaging outcomes were explored with correlation and regression analyses. Because CMB frequency increases with age, prevalence was investigated in participants at least 50 years of age and younger than 50 years. Results Significantly more patients with MS than HCs had CMBs (19.8% vs 7.4%, respectively; P = .01) in the group at least 50 years old. A trend toward greater presence of CMBs was found in patients with MS (P = .016) and patients with CIS who were younger than 50 years (P = .039) compared with HCs. In regression analysis adjusted for age, hypertension, and normalized brain volume, increased number of CMBs was significantly associated with increased physical disability in the MS population (R2 = 0.23, P < .0001). In correlation analysis, increased number of CMBs was significantly associated with deteriorated auditory and verbal learning and memory (P = .006) and visual information processing speed trends (P = .049) in patients with MS. Conclusion Monitoring CMBs may be relevant in patients with MS and CIS at higher risk for developing cognitive and physical disability. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Robert Zivadinov
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Deepa P Ramasamy
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Ralph R H Benedict
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Paul Polak
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Jesper Hagemeier
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Christopher Magnano
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Michael G Dwyer
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Niels Bergsland
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Nicola Bertolino
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Bianca Weinstock-Guttman
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Channa Kolb
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - David Hojnacki
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - David Utriainen
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - E Mark Haacke
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Ferdinand Schweser
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
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26
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Compta Y, Buongiorno M, Bargalló N, Valldeoriola F, Muñoz E, Tolosa E, Ríos J, Cámara A, Fernández M, Martí MJ. White matter hyperintensities, cerebrospinal amyloid-β and dementia in Parkinson's disease. J Neurol Sci 2016; 367:284-90. [PMID: 27423605 DOI: 10.1016/j.jns.2016.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/24/2016] [Accepted: 06/03/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Yaroslau Compta
- Parkinson disease & Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències (ICN), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Mariateresa Buongiorno
- Parkinson disease & Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències (ICN), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Núria Bargalló
- Magnetic Resonance Unit, Neurorradiology Section, Centre de Diagnòstic per la Imatge (CDI), IDIBAPS, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Francesc Valldeoriola
- Parkinson disease & Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències (ICN), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Esteban Muñoz
- Parkinson disease & Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències (ICN), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Eduardo Tolosa
- Parkinson disease & Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències (ICN), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - José Ríos
- Statistics and Methodologic Support Unit, Unitat d'Avaluació, Suport i Prevenció (UASP), Hospital Clínic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Ana Cámara
- Parkinson disease & Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències (ICN), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Manel Fernández
- Parkinson disease & Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències (ICN), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Maria J Martí
- Parkinson disease & Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències (ICN), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.
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